Traditional MedicareCoverageMedium impact
Proton Beam Therapy
Medicare/CMS - LCD·Radiation Oncology, Oncology·Local Coverage Determination
Effective date
Apr 1, 2026
We identified it
Jul 28, 2026
Summary
Unable to provide complete analysis. The policy document provided contains only metadata and header information (title, contractor, dates, and source URL) but does not include the actual policy content, coverage criteria, billing codes, prior authorization requirements, or clinical guidelines needed for medical billing team action.
Action Required
CRITICAL: Billing team must obtain the full policy text from the source URL (https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35075&ver=35) immediately. The complete LCD L35075 for Proton Beam Therapy (Wellpoint Federal) became effective 2026-04-01. Review the full policy to identify: (1) which CPT/HCPCS codes are affected, (2) prior authorization requirements, (3) medical necessity criteria, (4) covered diagnoses/conditions, and (5) any billing/documentation requirements. This is a high-priority new policy from 1 day ago that directly affects proton therapy billing. Failure to implement required changes by the effective date will result in claim denials. Assign this review to billing supervisor and clinical documentation specialist immediately.